Doctors: Lyme disease spreading

UPMC Altoona sees 160 percent jump in cases

August 5, 2013

A rash shaped like a bull's-eye, flu-like symptoms and Bell's palsy facial paralysis are some of the telltale signs of Lyme disease, and doctors across the region have been seeing more cases than usual this summer.

"Compared to last year, it's definitely higher," said Dr. Matthew Bouchard, chairman of UPMC Altoona's Emergency Medicine department, who said that during the past two months, UPMC doctors have treated more than 80 cases of Lyme disease.

That's a more than 160 percent jump from last year, when doctors treated only 31 cases total in June and July.

The most common tick-borne illness in the Northern Hemisphere, state health department officials said Lyme disease, caused by a bacteria carried by deer ticks, is spreading north and west across Pennsylvania, putting more of the population at risk.

In 2011, Lyme disease ranked sixth on the Centers for Disease Control and Prevention's nationally notifiable disease list despite not being a nationally occurring disease, with 96 percent of cases concentrated in 13 northeastern and upper midwestern states.

Fact Box

-- Tuck pants into socks, although ticks climb and will continue to look for exposed skin

-- Scan clothing and exposed skin often

-- Stay on well-traveled trails and avoid venturing into brush

-- Use insect repellant with DEET, diethyl-meta-toluamide, on skin and clothing

-- Don't sit on the ground or stone walls

-- Keep long hair tied back

-- Do a final full-body check at the end of the day for yourself, children and pets

-- Remember: Nymphal deer ticks are the size of poppy seeds, and adult deer ticks the size of apple seeds

Source: American Lyme Disease Foundation

Beth Hullihen, UPMC Bedford Memorial's infection prevention coordinator, said doctors have seen more cases over the past two years than at any other time in recent memory, with the jump between last summer's caseload and this summer's being the most dramatic.

And even though Tyrone Hospital doctors see most cases between September and October, emergency department manager Linda Irvin said since the season started in May, an usually high number of people have been coming in with tick bites.

"I don't know why we saw such an increase this year," she said.

Gillis said the number of cases in Pennsylvania fluctuates between 3,800 and 5,700 annually, with 5,033 cases reported last year.

As an endemic disease, meaning it affects every county in the state, Gillis said a year-to-year fluctuation in case statistics is normal and isn't cause for alarm.

There are a number of environmental factors that could have caused the spike, she said, including weather patterns, deer tick migration and urban sprawl, which contributes to the number of people exposed.

There could even be genetic changes to the tick itself or to the animals that harbor the ticks, so pinning down one cause from one year to another is difficult.

State health officials continually monitor state and regional trends to look for abnormalities and implement outbreak investigations when necessary, she said.

Hullihen said most people contract Lyme disease from being outdoors in places where ticks dwell, but it's also often the case that a tick gets on a family pet first and transfers the tick to its owner.

"Certainly, in our region, there's plenty of outdoor [activities] and good reasons to be outside," she said.

Irvin also noted that while tick bites are increasing, not all ticks carry the disease, and people shouldn't panic if they find one on their body.

Normally it takes a day or two for the disease to transmit if the tick does carry Lyme, she said, so if it's removed as soon as it's found, the chance of getting Lyme disease is greatly reduced.

People should get the bite examined if they start to see symptoms of Lyme disease, but Hullihen cautioned that looking for the bullseye-shaped rash isn't always successful.

"Not everybody gets a rash. That's the scary part of it," she said.

According to CDC estimates, approximately 70 to 80 percent of infected bites result in a rash, which normally shows up between three and 30 days after being bitten.

Other symptoms include joint and muscle aches or pains, headache, chills or a fever.

If someone waits longer to come in for treatment, they can even develop Bell's palsy, partial paralysis in their facial nerves.

"We have seen a number of cases of that this year," Bouchard said.

Most cases can be treated with an oral antibiotic, but more advanced stages of Lyme disease can cause heart and neurological problems, and symptoms may persist even after treatment, he said.

Without a vaccine or way to rid the state of the tick or its carriers, Gillis said the best means of preventing the spread of Lyme disease is education.

That means making people aware of the precautions they should take when outdoors but also encouraging local doctors to test for it.

The department's own data reporting and surveillance plays an important role, as well.

Hullihen said hospital directors maintain contact with the local state health department office so both stay informed but said preventing and catching Lyme disease most often falls to the individual.

"It's important for people to recognize potential exposure," she said, "and if they're symptomatic, if they have a fever, if they have a rash, if they have unexplained symptoms, they should contact their doctor."